Provider Demographics
NPI:1649282203
Name:WADE, DONNA LEE (LPC, LADC)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LEE
Last Name:WADE
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 NW 58TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-5912
Mailing Address - Country:US
Mailing Address - Phone:405-842-0543
Mailing Address - Fax:405-842-6223
Practice Address - Street 1:825 NW 58TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-5912
Practice Address - Country:US
Practice Address - Phone:405-842-0543
Practice Address - Fax:405-842-6223
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1904101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health